MDs Delayed Saturday mid morning Snack/COVID lunch


P.S. ProfG has a sense of humour and has not taken offence by the contents of this post

So for this/last weeks tasting menu we start with

Alemtuzumab and antibody responses…I predict good news based on natural infection

Iovino A, Olivieri N, Aruta F, Giaquinto E, Ruggiero L, Spina E, Tozza S, Manganelli F, Iodice R. Alemtuzumab in Covid era. Mult Scler Relat Disord. 2021 Mar 18;51:102908. doi: 10.1016/j.msard.2021.102908.

Background: The SARS-CoV-2 pandemic impact on people with Multiple Sclerosis (pwMS) continues to worry. The disease modifying therapies in pwMS can add a more severe risk of infection when compared to the general population. Alemtuzumab is an anti-CD52 monoclonal antibody and it is one of the most immunosuppressive drugs used in Multiple Sclerosis (MS).

Case description: We present a case of Covid-19 infection that occurred in a 24-year-old woman with MS and treated with alemtuzumab. The infection occurred 4 months after administration of the first course of alemtuzumab and had a benign course with subsequent development of antibodies. Furthermore, we present a brief review of the literature on similar published cases.

Discussion: We reviewed 17 articles concerning COVID-19 infection in MS patients in treatment with Alemtuzumab. In our case and all screened cases no severe course of disease was noted and no fatality was observed. Systematic compilation of this observation comforts clinicians about the course of Covid-19 infection despite alemtuzumab immunosuppressive treatment CONCLUSIONS: The risk of serious COVID-19 disease in MS patients treated with alemtuzumab is unknown. Physicians need to monitor carefully pwMS treated with alemtuzumab and to consider COVID-19 infection related relapse in the MS patients.

So this is good news for vaccinators if you can make anti-COVID-19 antibodies after infection you can make a vaccine response

What do you need for Vaccine Confidence? It’s not just COVID.

Vaccine Hesitancy in Patients With Multiple Sclerosis: Preparing for the SARS-CoV-2 Vaccination Challenge.Diem L, Friedli C, Chan A, Salmen A, Hoepner R.Neurol Neuroimmunol Neuroinflamm. 2021; 8(3):e991.

Objective: Vaccine hesitancy is a complex public health issue referring to concerns about safety, efficacy, or need for vaccination. Using pneumococcal vaccination, which is recommend in anti-CD20-treated multiple sclerosis (MS) patients, as a model, we assessed vaccination behavior in patients with MS to prepare for the upcoming SARS-CoV-2 vaccination challenge.

Methods: By a medical chart review, we retrospectively identified patients with MS treated with ocrelizumab at the University Hospital Bern in 2018-2020. Pneumococcal vaccination was discussed with the patients during clinical visits and highlighted in the after-visit summary addressed to the general practitioner before ocrelizumab initiation as part of our clinical standard of care.

Results: Pneumococcal vaccination was performed in 71/121 (58.7%) of patients, and 50/121 (41.3%) patients were not vaccinated. Patients who did not get a pneumococcal vaccination were younger (no vaccination vs vaccination; mean [95% CI] 40.1 [36.1-44.1] vs 45.4 [41.9-48.8], p = 0.028) and had more frequently a relapsing remitting disease course (no vaccination vs vaccination, n [%]; 43/50 [86.0%] vs 49/71 [69.0%], p = 0.031). Furthermore, patients who did not get vaccination had more frequently a history of comorbid psychiatric disorder (no vaccination vs vaccination, n (%); 12/50 [24.0] vs 7/71 [9.8], p = 0.035).

Conclusion: Our study demonstrated that in our single-center cohort, 41.3% of patients with MS do not get the recommended pneumococcal vaccination. Future research should focus on vaccine hesitancy in the vulnerable cohort of patients with MS to improve the safety of MS immunotherapies.

So naughty naughty, what do we do to creat vaccine confidence?

You asked how long after vaccine does your antibody last?

Comprehensive assessment of humoral response after Pfizer BNT162b2 mRNA Covid-19 vaccination: a three-case seriesDanese, E., Montagnana, M., Salvagno, G. L., Gelati, M., Peserico, D., Pighi, L., De Nitto, S., Henry, B. M., Porru, S., Lippi, G.10.1101/2021.03.19.21253989 — Posted: 2021-04-04

Background. Since universal vaccination is a pillar against coronavirus disease 2019 (COVID-19), monitoring anti-SARS-CoV-2 neutralizing antibodies is essential for deciphering post-vaccination immune response.

Methods. Three healthcare workers received 30 μg BNT162b2 mRNA Covid-19 Vaccine, followed by a second identical dose, 21 days afterwards. Venous blood was drawn at baseline and at serial intervals, up to 63 days afterwards, for assessing total immunoglobulins (Ig) anti-RBD (receptor binding domain), IgG anti-S1/S2, IgG anti-RBD, IgM anti-RBD, IgM anti-N/S1 and IgA anti-S1.

Results. All subjects were SARS-CoV-2 seronegative at baseline. Total Ig anti-RBD, IgG anti-S1/S2 and IgG anti-RBD levels increased between 91-368 folds until 21 days after the first vaccine dose, then reached a plateau. The levels raised further after the second dose (by ~30-, ~8- and ~8-fold, respectively), peaking at day 35, but then slightly declining and stabilizing ~50 days after the first dose. IgA anti-S1 levels increased between 7-11 days after the first dose, slightly declined before the second dose, after which levels augmented by ~24-fold from baseline. The anti-RBD and anti-N/S1 IgM kinetics were similar to that of anti-S1 IgA, though displaying substantially weaker increases and modest peaks, only 4 to 7-fold higher than baseline. Highly significant inter-correlation was noted between total Ig anti-RBD, anti-S1/S2 and anti-RBD IgG (all r=0.99), whilst other anti-SARS-CoV-2 antibodies displayed lower, though still significant, correlations. Serum spike protein concentration was undetectable at all time points.

Conclusions. BNT162b2 mRNA vaccination generates a robust humoral immune response, especially involving IgG and IgA, magnified by the second vaccine dose.

The immune response is visible for a while but if there is no virus around to keep it interested it will soon go, but it can come back at a days notice

What about the Moderna vaccine?

Doria-Rose et al. Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19.DOI: 10.1056/NEJMc2103916

Interim results from a phase 3 trial of the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine indicated 94% efficacy in preventing coronavirus disease 2019 (Covid-19). The durability of protection is currently unknown. We describe mRNA1273-elicited binding and neutralizing antibodies in 33 healthy adult participants in an ongoing phase 1 trial, stratified according to age, at 180 days after the second dose of 100 μg (day 209).

It seems that they are going to give the Moderna vaccine to the youth. I think there may be some logic to this.

I think the Moderna vaccine probably gives the biggest antibody response and uses 3 times more RNA than the Pfizer vaccine.As you can see it has reached maximum before dose 2 and then it remains high for 6 months. Who are most likely to catch and spread the virus.?…yep the twenty somethings. They will be partying like there is no 2020/2021 but by having a high antibody response it is likely to remain sterilizing (you catch the virus you get rid of it before you pass it on). The data above looks good but it does not show the spread to see how many people do not response well but most people do.

The occurrence of COVID-19 in Spain is not quite as high as the abstract suggests.

The level of antibodies is reported at 83% impling that 83% of people have been infected with the virus and made an antibody response…The occurence of COVID-19 in the MS population was not that high.

Piñar Morales R, Ramírez Rivas MA, Barrero Hernández FJ. SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis. Neurologia. 2021 Mar 19:S0213-4853(21)00058-X

Introduction: The effect of SARS-CoV-2 infection in patients with multiple sclerosis (MS) and the influence of disease-modifying therapies (DMT) for MS on COVID-19 are unknown. To date, patients with MS have not been shown to present greater risk of COVID-19 or more severe progression of the disease.

Methods: We performed a descriptive study of patients with MS presenting SARS-CoV-2 infection diagnosed with PCR. We analysed demographic, clinical, laboratory, and treatment variables in our sample. Presence of antibodies against the virus was also determined.

Results: Relapsing-remitting MS (RRMS) was the most frequent form of MS in our sample. Prognosis was unfavourable in 10.2% of patients, and was associated with older age and higher scores on the Expanded Disability Status Scale (EDSS). Seroprevalence of antibodies against SARS-CoV-2 was 83.3% in our sample (but they only looked at 24 people and they had all been tested positive in the past. The total population was 475 of which only 28 had PCR confirmed COVID-19). Development of antibodies was not associated with DMT, lymphocytopaenia, or any of the other variables analysed.

Conclusions: The incidence of COVID-19 was slightly lower in our sample than in the general population in our province. Unfavourable prognosis was associated with older age and higher EDSS scores. DMT and lymphocytopaenia did not influence the clinical course of COVID-19. Seroprevalence of antibodies against the virus in our sample was similar to that reported for the general population with positive PCR results for the virus; the influence of specific DMTs could not be determine

Covid Vaccine for Mums-to-be…..Looking Good

Mums-to be get vaccinated….Antibody crosses the placenta (As expected in immunology 101). Baby protected

Efficient Maternal to Neonatal transfer of SARS-CoV-2 and BNT162b2 antibodies Ofer Beharier, Romina Plitman Mayo, Tal Raz, Kira Nahum Sacks, Letizia Schreiber, Yael Suissa-Cohen, Rony Chen, Rachel Gomez-Tolub, Eran Hadar, Rinat Gabbay-Benziv, Yuval Jaffe Moshkovich, Tal Biron-Shental, Gil Shechter-Maor, Sivan Farladansky-Gershnabel, Hen Yitzhak Sela, Hedi Benyamini-Raischer, Nitzan D Sela, Debra Goldman-Wohl, Ziv Shulman, Ariel Many, Haim Barr, Simcha Yagel, Michal Neeman, Michal Kovo MEDRXIV doi:

Background: The significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired foetal immune response, potentially providing newborn protection. Methods: A multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to three study groups: vaccinated (n=86); PCR confirmed SARS-CoV-2 infected during pregnancy (n=65), and unvaccinated non-infected controls (n=62). Maternal and foetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD and N). Results: BNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (Anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal anti-COVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer rate was significantly lower for third-trimester as compared to second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group. Conclusions: Antenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the foetus, supporting the role of vaccination during pregnancy.

Immunosuppression (in Transplants) stops immune responses

Impaired Humoral and Cellular Immunity after SARS-CoV2 BNT162b2 (Tozinameran) Prime-Boost Vaccination in Kidney Transplant RecipientsSattler, A., Schrezenmeier, E., Weber, U., Potekhin, A., Bachmann, F., Budde, K., Storz, E., Pross, V., Bergmann, Y., Thole, L., Tizian, C., Hoelsken, O., Diefenbach, A., Schrezenmeier, H., Jahrsdoerfer, B., Zemojtel, T., Jechow, K., Conrad, C., Lukassen, S., Stauch, D., Lachmann, N., Choi, M., Halleck, F., Kotsch, K.10.1101/2021.04.06.21254963 — Posted: 2021-04-07

Novel mRNA-based vaccines have been proven powerful tools to combat the global pandemic caused by SARS-CoV2 with BNT162b2 efficiently protecting individuals from COVID-19 across a broad age range. We therefore comprehensively analyzed humoral and cellular responses in kidney transplant recipients after prime-boost (two doses) vaccination with BNT162b2. As opposed to all healthy vaccinees and the majority of hemodialysis patients, only 4/39 and 1/39 transplanted individuals showed IgA and IgG seroconversion at day 8±1 after booster immunization with minor changes until day 23±5, respectively. Therefore there was less poor seroconversion from with continuous immunosuppression.However most patients mounted spike-specific T helper cell responses, frequencies were significantly reduced compared to controls, accompanied by a broad impairment in effector cytokine production, memory differentiation and activation-related signatures. Spike-specific CD8+ T cell responses were less abundant than their CD4+ counterparts in healthy controls and hemodialysis patients and almost undetectable in transplant patients. So this is not good news and perhaps means that use of COVID-19 protective antibodies could be useful. In summary, our data strongly suggest revised vaccination approaches in immunosuppressed patients, including individual immune monitoring for protection of this vulnerable group at risk to develop severe COVID-19.

Arthritis News from Israel…Why is this relevant..Because they use anti-CD20

As you can see 11/19 (58%…Not sure this is right as the numers dont add up and there were n=25 B cell depleters) did not seroconvert. Now you have to remember that in Arthritis they often take methotrexate with the anti-CD20 so it is not like in MS and 9/19 (47%) on rituximab (1.5-12 months before) converted. Compare this to anti-BAFF which doesnt deplete memory B cells but does kill plasma cells and the mature B cells that will make the vaccine responses and only 1/6 (17%) seroconverted

Humoral response to Pfizer mRNA vaccine against SARS CoV2, in patients with autoimmune inflammatory rheumatic diseases and the impact on the rheumatic disease activityBraun-Moscovici, Y., Kaplan, M., Markovits, D., Giryes, S., Toledano, K., Tavor, Y., Dolnikov, K., Balbir-Gurman, A.10.1101/2021.04.02.21254493 — Posted: 2021-04-06

Abstract Background: The registration trials of mRNA vaccines against SARS CoV2 did not address patients with autoimmune inflammatory rheumatoid diseases (AIRD). Aims: To assess the humoral response to mRNA vaccine against SARS CoV2, in AIRD patients treated with immunomodulating drugs and the impact on AIRD activity. Methods: Consecutive patients treated at the rheumatology institute who received their first SARS-CoV-2 (Pfizer) vaccine were recruited to the study, at their routine visit. The patients were invited for serology test 4-6 weeks after receiving the second dose of vaccine. IgG Antibodies (Ab) against SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay Results: One hundred fifty-six consecutive patients (76% females) treated at a single rheumatology center (mean age (range) 59.1 (21-83) years), mean (range) disease duration 10.8 (1-55) years), were recruited to the study. Thirty-five percents of patients received conventional synthetic (cs)DMARDs only, 64% biological/targeted synthetic (b/ts) DMARDs, 34% received combined treatment with csDMARDs and b/tsDMARDs and 32% corticosteroids (mean dose(range) 5.8mg(2.5-20mg) prednisone). One hundred thirty-seven patients (88%) were seropositive for IgG Ab against SARS CoV2 virus (median 2832.5 AU/ml, range 58-29499). Nineteen (12%) patients had negative tests, 11/19 were treated with B cell depleting agents. The reported side effects of the vaccine were minor (muscle sore, headache, low grade fever). The rheumatic disease remained stable in all patients. Conclusions: The vast majority of AIRD patients developed a significant humoral response following the administration of the second dose of the Pfeizer mRNA vaccine against SARS CoV2 virus. Only minor side effects were reported and no apparent impact on AIRD activity was noted.

Another in cancer indicates that B cell depletion limits the antibody response

Efficacy of the BNT162b2 mRNA COVID19 Vaccine in Patients with Chronic Lymphocytic Leukemia.Herishanu Y, Avivi I, Aharon A, Shefer G, Levi S, Bronstein Y, Morales Moshiashvili M, Ziv-Baran T, Shorer Y, Scarfo L, Joffe E, Perry C, Ghia P.Blood. 2021 Apr 16:blood.2021011568. doi: 10.1182/blood.2021011568. 

Patients with blood-related cancer have an increased risk for severe COVID-19 disease and mortality. We evaluated humoral immune responses to BNT162b2 mRNA COVID-19 vaccine in patients with cancer and compared responses with those obtained in age-matched healthy controls. Patients received two vaccine doses, 21 days apart, and antibody titers were measured using Elecsys® Anti-SARS-CoV-2S assay after administration of the second dose. A comparison between 52 patients with cancer and 52 sex- and aged-matched healthy controls, revealed a significantly reduced response rate among patients (52% vs 100%, respectively; adjusted odds ratio=0.010, 95% CI 0.001-0.162; p<0.001). In patients treated with either BTK inhibitors or venetoclax ± anti-CD20 antibody, response rates were considerably low (16.0% and 13.6%, respectively). None of the patients exposed to anti-CD20 antibodies less than 12 months prior to vaccination responded.

SARS-CoV-2 Immunogenicity in individuals infected before and after COVID-19 vaccination: Israel, January-March 2021: Implications for vaccination policyAbu Jabal, K., Ben Amram, H., Beiruti, K., Brimat, I., Abu Saada, A., Bathish, Y., Sussan, C., Zarka, S., Edelstein, M.10.1101/2021.04.11.21255273 

Between December 2020-March 2021 we measured anti-SARS-CoV-2 IgG titers post-vaccination with the BNT162b2 vaccine among 725 Israeli hospital workers. Previously infected individuals who received one dose had higher IgG titres than fully vaccinated, never-infected workers. Post-vaccination infection did not increase IgG titres. Individuals infected post-dose one should receive the second..

There have been at least twenty papers on this subject. Ifyou have been infected naturally, you are likely to

There are many B cell agents that are not MS drugs so avoid the headlines…But is a solution surfacing?

Deepak P et al. Glucocorticoids and B Cell Depleting Agents Substantially Impair Immunogenicity of mRNA Vaccines to SARS-CoV-2. MedRxiv

We have reported a study suggesting some depletion with anti-TNF drugs not used in MS and with this papepr and others it is now 3/1 that there is not a major impact verses about 6/0 that B cell depleters have an impact. The headline here is a warning about B cell depleters but there were only about 12 people on an MS depleting drug. However, there was some seroconversion. For rituximab between 6/12 months after infusion 4/5 sero converted. I suspect this is becausse the anti-CD20 antibody wains allowing B cells to recover and respond. So beginning of an indication of how to get a B cell response in CD20-depleted, but we need more data. Maybe MS-Margaret Keenan has hit on the solution, but we must wait for data to surface as ocrelizumab is a stronger depletor compared to rituximab

At last some Good Ocrelizumab Vaccine News from A Blog Reader.

Clearly one can’t confirm any of the information but why lie and I think the Anon is the MS-Margaret Keenan…No they are no 90 years old… but they were probably the first person with MS to get the post licensing vaccine dose on December 8 2020. The post is “I have some good news for ocrelizumab patients (although n=1 but better than nothing!). I had my two doses of vaccine (Pfizer) 9 months after my last infusion of ocrelizumab. I had been on the medication for 1 year but chose to delay my next dose in the hope of a vaccine. I have sent my blood to the diagnostics lab which tests for spike protein antibodies. I have heard today that I am positive for SARS COV-2 specific antibodies. Very relieved!! So it is possible to mount a response despite anti CD20 medication”. The response was very good with a 4/5 antibody level. This is excellent news we will have to wait and see if this experiment gives a reproducible response, but it is good there was no disease activity seen in this individual. I think we will see safety data surfacing on this very issue as many people had their infusions delayed.

T cells to the rescue

Cross-reactive CD4+ T cells enhance SARS-CoV-2 immune responses upon infection and vaccination Loyal, L., Braun, J., Henze, L., Kruse, B., Dingeldey, M., Reimer, U., Kern, F., Schwarz, T., Mangold, M., Unger, C., Doerfler, F., Kadler, S., Rosowski, J., Guercan, K., Uyar-Aydin, Z., Frentsch, M., Kurth, F., Schnatbaum, K., Eckey, M., Hippenstiel, S., Hocke, A., Mueller, M. A., Sawitzki, B., Miltenyi, S., Paul, F., Mall, M. A., Wenschuh, H., Voigt, S., Drosten, C., Lauster, R., Lachmann, N., Sander, L.-E., Corman, V. M., Roehmel, J., Meyer-Arndt, L. A., Thiel, A. M., Giesecke-Thiel, C.10.1101/2021.04.01.21252379 — Posted: 2021-04-05

While evidence for pre-existing SARS-CoV-2-cross-reactive CD4+ T cells in unexposed individuals is increasing, their functional significance remains unclear. Here, we comprehensively determined SARS-CoV-2-cross-reactivity and human coronavirus-reactivity in unexposed individuals. SARS-CoV-2-cross-reactive CD4+ T cells were ubiquitous, but their presence decreased with age. Within the spike glycoprotein fusion domain, we identified a universal immunodominant coronavirus-specific peptide epitope (iCope). Pre-existing spike- and iCope-reactive memory T cells were efficiently recruited into mild SARS-CoV-2 infections and their abundance correlated with higher IgG titers. Importantly, the cells were also reactivated after primary BNT162b2 COVID-19 mRNA vaccination in which their kinetics resembled that of secondary immune responses. Our results highlight the functional importance of pre-existing spike-cross-reactive T cells in SARS-CoV-2 infection and vaccination. Abundant spike-specific cross-immunity may be responsible for the unexpectedly high efficacy of current vaccines even with single doses and the high rate of asymptomatic/mild infection courses.

There are T cell escape variants just like there are B cell escape variants

The T cell response is no different to B cells and there are variants that T cells are not good at getting rid of. There are T cell escape variants just like there are B cell escape variants You have heard about the Brazilian (its called P.1), the Hollywood (actually it’s called the Californian), the French Bikini (A new variant from Brittany), the Vajazzle (UK variant, although it comes from Kent not Essex:-) and the South African (Check out ProfGs pelvic Xrays to see the hair cut there…Just a little Joke :-). These are variants of the SARS-CoV-2 that are of concern because they affect infection rates and the ability for the B cell response to get rid of the virus. The T cell response is no different and there are variants that T cells are not good at getting rid of 

Thushan I de Silva, Guihai Liu, Benjamin B Lindsey, Danning Dong, Dhruv Shah, Alexander  Mentzer, Adrienn Angyal, Rebecca Brown, MatthewD Parker, Zixi Yin, Xuan Yao, Lance Turtle, Susanna Dunachie, COVID-19 Genomics UK (COG-UK) Consortium, Mala K Maini, Graham Ogg, Julian Charles Knight, Yanchun Peng, Sarah L Rowland-Jones, Tao Dong MedRXiv doi:

We identify amino acid variants within dominant SARS-CoV-2 T-cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T-cells assessed by IFN-γ and cytotoxic killing assays. These data demonstrate the potential for T-cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T-cell as well as humoral immunity.

However, before you start to worry. Don’t. These are irrelevant for most vaccines as they are against Spike and importantly if there is a hole in the repertoire for T cells, it is likely there wont be for the B cells and vice versa

Humoral and cellular immune responses against SARS-CoV-2 variants and human coronaviruses after single BNT162b2 vaccination.

Metodi Stankov, Anne Cossmann, Agnes Bonifacius, Alexandra Jablonka, Gema Morillas Ramos, Nina Goedecke, Anna Zychlinsky Scharff, Christine Happle, Anna-Lena Boeck, Anh Thu Tran, Isabell Pink, Marius M Hoeper, Rainer Blasczyk, Martin Winkler, Inga Nehlmeier, Amy Kempf, Heike Hofmann-Winkler, Markus Hoffmann, Britta Eiz-Vesper, Stefan Poehlmann, Georg Behrensdoi:

Vaccine-induced neutralizing antibodies are key in combating the COVID-19 pandemic. However, delays of boost immunization due to limited availability of vaccines may leave individuals vulnerable to infection and disease for prolonged periods. The emergence of SARS-CoV-2 variants of concern (VOC), B.1.1.7 (United Kingdom), B.1.351 (South Africa) and P.1 (Brazil), may reinforce this issue with the latter two being able to evade control by antibodies. We assessed humoral and T cell responses against SARS-CoV-2 WT and VOC and endemic human coronaviruses (hCoV) that were induced after single and double vaccination with BNT162b2. Despite readily detectable IgG against the receptor-binding domain (RBD) of the SARS-CoV-2 S protein at day 14 after a single vaccination, inhibition of SARS-CoV-2 S-driven host cell entry was weak and particularly low for the B.1.351 variant. Frequencies of SARS-CoV-2 specific T cells were low in many vaccinees after application of a single dose and influenced by immunity against endemic hCoV. The second vaccination significantly boosted T cell frequencies reactive for WT, B.1.1.7 and B.1.351 variants. These results call into question whether neutralizing antibodies significantly contribute to protection against COVID-19 upon single vaccination and suggest that cellular immunity is central for the early defenses against COVID-19.

So this says T cells are important but I told you this about a year ago. Astrazeneca jab gives you a T cell response after one dose

Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.

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  • “The infection occurred 4 months after administration of the first course of alemtuzumab and had a benign course with subsequent development of antibodies.”

    This is interesting

    I heard you say manny moons ago that alemtuzumab “zap” those b memory b cell (also t cells)

    So with no memory b cells around how do you make antibody responses?

    Are they hiding somewhere?

    Alemtuzumab works in MS because it depletes memory B cells

    • Good point.
      I think with alemtuzumab, because the dose 36-60mg is relatively low, it does not clear the lymph glands and bone marrow, so I suspect cells capably of turning into memory cells are preserved and by the time the immature B cells are memory B cells the alemtuzumab has already gone from the body. However the germinal centre cells may form plasma blasts (which are low in CD20 and you possibly dont need memory B cells t getthese cells

  • Very useful post thanks

    Piñar Morales R, Ramírez Rivas MA, Barrero Hernández FJ. SARS-CoV-2 infection and seroprevalence in patients with multiple sclerosis. Neurologia. 2021 Mar 19:S0213-4853(21)00058-X

    Just a side not


    Its a very nasty word in Portuguese



  • The toes on my left foot have been numb on and off since a few hours after my second phizer shot one week ago… I took paracetamol before and after, and avoided a fever… this is not a knew symptom, I’ve been vaguely aware of it it before but it’s for sure more prevalent than I’ve ever had it before, would this still be in keeping with vaccine response and a flare, not new permanent damage?

  • I feel famous!!

    I can certainly confirm that all of the anonymous info I previously gave, is true.

    I am 39 years old with RRMS, so not 90 like Margaret Keenan!

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